First Name: * required

Last Name: * required

Phone: * required

Mobile Phone:  

Email Address:  

Address:  

City:  

State: (select from drop down) AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY  

ZIP Code: (5 or 9 digits)  -

When was the house built? (year)  

How long have you owned the house?  Years    Months

Type of house: (select from list) Single Story Two Story Split Level Town house Ranch house Condominium A frame Duplex Log home Mobile home Other  

Size of house in square feet  

Foundation: (select from list) Slab Wood Basement Crawl Space Other  

Exterior finish: (select from list) Brick/Block Stucco Vinyl Siding Wood Siding Rock Shingle Other  

Roof type: Shingle Shake Tile Metal Other  

Bedrooms: (select from list) 1 bedroom 2 bedrooms 3 bedrooms 4 bedrooms 5 bedrooms 6 bedrooms 7 bedrooms 8 bedrooms more  

Bathrooms: (select from list) 1 bathroom 1½ bathrooms 2 bathrooms 2½ bathrooms 3 bathrooms 3½ bathrooms 4 bathrooms 4½ bathrooms more  

Garage: (select from list) None 1 car garage 2 car garage 3 car garage 1 car carport 2 car carport Other  

Is garage attached to house? (check) Yes        No

Condition (select from list) Excellent Very Good Good Needs minor repairs Poor Unlivable  

Is the property occupied? (select)   Yes       No

Is the property listed with a Realtor?   Yes       No

If YES, when does listing expire?  

How much do you owe on the house? $

How much is the house worth? $

First Mortgage Balance: $

First Mortgage Payment: $

Interest Rate:  %

First Mortgage Holder:  

Second Mortgage Balance: $

Second Mortgage Payment: $

Interest Rate:  %

Second Mortgage Holder:  

Do you have a line of equity on this property?   No       Yes

Balance:$

Payment:$

Interest Rate:  %

Holder:  

Are payments current?   Yes       No

If NO, how far behind are the payments?  months/payments

Amount behind: $

Have you received a  warning from your lender?  No       Yes

Have you received a notice of Foreclosure?  No       Yes

Is the house attached to a Bankruptcy?  No       Yes

What is your asking price? $

How soon do you need to sell your property? Immediately Within 30 Days Within next 6 months Within the year Beyond 12 months  

Currently rented?  If so, at what monthly rent?

Are there signed leases?  If so, when do they expire?

Is there anything else you want us to know to help you? Anything else you want to know?